Provider Demographics
NPI:1194893867
Name:NELSON, JOSEPH ALTON (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALTON
Last Name:NELSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10007 SHINNAMON DR SW
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-6149
Mailing Address - Country:US
Mailing Address - Phone:301-777-7959
Mailing Address - Fax:
Practice Address - Street 1:944 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1821
Practice Address - Country:US
Practice Address - Phone:301-777-5020
Practice Address - Fax:301-777-7915
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD48371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice